{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T14:17:56Z","timestamp":1768313876249,"version":"3.49.0"},"reference-count":29,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Assessment of disease severity in interstitial lung disease (ILD) is usually performed using lung function tests, exercise testing, and chest imaging. Each modality has its own benefits and drawbacks. Ultrasound (USG) examination of the diaphragm is a non-invasive imaging modality that has been found to be effective in evaluating diseases like chronic obstructive pulmonary disease and asthma. However, its role in the assessment of stable ILD has been scarcely evaluated. We conducted a cross-sectional study to evaluate the role of diaphragmatic USG in the assessment of disease severity in 55 stable ILD patients. After clinical evaluation, all patients underwent spirometry [forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC)], high-resolution computed tomography (HRCT) of the thorax and 6-minute walk test as per standard criteria. The Warrick score was calculated using HRCT to quantify the radiological extent of disease. Thereafter, USG was performed, and diaphragmatic excursion (DE) and thickness were measured during both quiet and deep breathing (DB). Dyspnea grade, spirometry values, 6-minute walk distance (6MWD), and the Warrick score were correlated with USG variables to assess for any possible association. The mean age of the patients was 57.6\u00b112.8 years (M:F=1:1). Idiopathic pulmonary fibrosis (n=15) was the most common ILD. The median FVC%, FEV1%, 6MWD, and Warrick score of the patients were 60 (48-74), 68 (53-90), 360 (245-400) m, and 18 (14-22), respectively. Out of 5 USG variables studied, thickening fraction, DE &amp; diaphragmatic thickness (DB) showed statistically significant correlation (p&lt;0.05) with dyspnea grade, FVC, 6MWD, and Warrick score in decreasing order of strength. On logistic regression analysis, FVC was the only factor that independently predicted thickening fraction (adjusted odds ratio: -1.08; 95% confidence interval 1.03-1.13; p=0.003). Diaphragmatic mobility and thickness showed a strong correlation with dyspnea, lung functions, exercise capacity, and radiological extent of disease in ILD patients. USG of the diaphragm can play an effective role in the assessment of disease severity in ILD.<\/jats:p>","DOI":"10.4081\/monaldi.2026.3533","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T08:32:11Z","timestamp":1768293131000},"source":"Crossref","is-referenced-by-count":0,"title":["Role of diaphragmatic ultrasound in the assessment of disease severity in stable interstitial lung disease patients"],"prefix":"10.4081","author":[{"given":"Siddharth","family":"Tomar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2476-3371","authenticated-orcid":false,"given":"Deepak","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Komaldeep","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varinder","family":"Saini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravinder","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"70164","doi-asserted-by":"crossref","unstructured":"Raghu G, Collard HR, Egan JJ, et al. 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Use of 6-minute walk test for assessing severity of interstitial lung disease: an observational study. Sarcoidosis Vasc Diffuse Lung Dis 2023;40:e2023013."},{"key":"70169","doi-asserted-by":"crossref","unstructured":"Faithfull D, Jones JG, Jordan C. Measurement of the relative contributions of rib cage and abdomen\/diaphragm to tidal breathing in man. Br J Anaesth 1979;51:391-8.","DOI":"10.1093\/bja\/51.5.391"},{"key":"70170","doi-asserted-by":"crossref","unstructured":"Chiang E, Kessler DO, Liebman M, Rabiner JE. Diaphragmatic ultrasound in children with asthma exacerbations. Pediatr Emerg Care 2024;40:603-6.","DOI":"10.1097\/PEC.0000000000003162"},{"key":"70171","unstructured":"Kakhaki HES, Alesaeidi S, Siri G, et al. Diaphragmatic ultrasound advantages in chronic obstructive pulmonary disease (COPD) patients: a systematic review and metaanalysis. Ethiop J Health Sci 2023;33:903-12."},{"key":"70172","doi-asserted-by":"crossref","unstructured":"Nason LK, Walker CM, McNeeley MF, et al. Imaging of the diaphragm: anatomy and function. Radiographics 2012;32:E51-70.","DOI":"10.1148\/rg.322115127"},{"key":"70173","doi-asserted-by":"crossref","unstructured":"DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax 2014;69:423-7.","DOI":"10.1136\/thoraxjnl-2013-204111"},{"key":"70174","doi-asserted-by":"crossref","unstructured":"Santana PV, Prina E, Albuquerque AL, et al. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging. J Bras Pneumol 2016;42:88-94.","DOI":"10.1590\/S1806-37562015000000266"},{"key":"70175","doi-asserted-by":"crossref","unstructured":"Boccatonda A, Decorato V, Cocco G, et al. Ultrasound evaluation of diaphragmatic mobility in patients with idiopathic lung fibrosis: a pilot study. Multidiscip Respir Med 2019;14:1.","DOI":"10.1186\/s40248-018-0159-y"},{"key":"70176","doi-asserted-by":"crossref","unstructured":"de Troyer A, Yernault JC. Inspiratory muscle force in normal subjects and patients with interstitial lung disease.Thorax 1980;35:92-100.","DOI":"10.1136\/thx.35.2.92"},{"key":"70177","doi-asserted-by":"crossref","unstructured":"Panagiotou M, Polychronopoulos V, Strange C. Respiratory and lower limb muscle function in interstitial lung disease. Chron Respir Dis 2016;13:162-72.","DOI":"10.1177\/1479972315626014"},{"key":"70178","doi-asserted-by":"crossref","unstructured":"Santana PV, Cardenas LZ, de Albuquerque ALP, et al. Diaphragmatic ultrasound findings correlate with dyspnea, exercise tolerance, health-related quality of life and lung function in patients with fibrotic interstitial lung disease. BMC Pulm Med 2019;19:183.","DOI":"10.1186\/s12890-019-0936-1"},{"key":"70179","doi-asserted-by":"crossref","unstructured":"Banerjee S, Sanjan G, Sharma P, et al. Correlation of diaphragmatic mobility and thickening assessed by lung ultrasound with severity of interstitial lung disease. Lung India 2024;41:345-52.","DOI":"10.4103\/lungindia.lungindia_139_24"},{"key":"70180","doi-asserted-by":"crossref","unstructured":"Singh S, Sharma BB, Bairwa M, et al. Management of interstitial lung diseases: a consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP). Lung India 2020;37:359-78.","DOI":"10.4103\/lungindia.lungindia_275_20"},{"key":"70181","doi-asserted-by":"crossref","unstructured":"Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS\/ERS\/JRS\/ALAT clinical practice guideline. 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Steroid-induced myopathy and its significance to respiratory disease: a known disease rediscovered. Eur Respir J 1992;5:997-1003.","DOI":"10.1183\/09031936.93.05080997"},{"key":"70190","doi-asserted-by":"crossref","unstructured":"Holland AE. Exercise limitation in interstitial lung disease - mechanisms, significance and therapeutic options. Chron Respir Dis 2010;7:101-11.","DOI":"10.1177\/1479972309354689"},{"key":"70191","doi-asserted-by":"crossref","unstructured":"Lewi\u0144ska A, Shahnazaryan K. The use of diaphragm ultrasonography in pulmonary physiotherapy of COPD patients: a literature review. J Clin Med 2020;9:3525.","DOI":"10.3390\/jcm9113525"},{"key":"70192","doi-asserted-by":"crossref","unstructured":"Shen H, Xu Y, Zhang Y, Ren L, Chen R. correlation between diaphragmatic excursion and exercise tolerance improvement following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome. 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